I have the SAME problem. I have a lot of heath problems that require a narcotic such as Lortab and Perc daily and including post-op pain. Stadol Nasal Spray kills all pain. I origionally took it for migraine and it would take a killer migriane and have me comfortable, if not asleep, in 5 minutes. I started using it for other pain and it was the best. (they can administer it IV or IM in the hospital if you request it) I also use Fiorocet w/ codiene for migraine. That will rid the migraine, for me, but sometimes not strong enough for other pain. My last resort is to take Excedrin w/ the Lortab or Perc, I know the acetaminophen becomes an issue, so I keep that in mind. The only other solution is Imetex and your pain meds. Hope I've helped. I know how horrible migraines are. A lot of people don't understand not all pain meds help every type of pain. Maybe they can give you oxycontin after your knee replacement. That didn't trigger migraine, for me, like the other meds. Best of luck.